
- With Mayo Clinic certified nurse-midwife
Mary M. Murry, R.N., C.N.M.
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Mary M. Murry, R.N., C.N.M.
Mary M. Murry, R.N., C.N.M.
Mary Murry is a certified nurse-midwife in the Department of Obstetrics & Gynecology at Mayo Clinic, Rochester, Minn.
Murry, a Cincinnati native, has been a nurse-midwife practitioner for more than 20 years and is an instructor at the College of Medicine, Mayo Clinic. She was a contributing reviewer and writer of the "Mayo Clinic Guide to a Healthy Pregnancy" book.
Her research interests include adult female survivors of sexual abuse, women's perception of pain in labor, and obesity in pregnancy.
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Jan. 23, 2009
Study looks at C-section before 39 weeks
By Mary M. Murry, R.N., C.N.M.
Some of you might have heard or read in the news lately about elective delivery before 39 weeks gestation.
There was a study published Jan. 9th in the New England Journal of Medicine concerning the timing of elective repeat C-section delivery at term and the outcomes for the newborns.
The conclusion was that elective repeat C-section before 39 weeks is associated with respiratory complications and other adverse neonatal outcomes.
The American College of Obstetrics and Gynecologists has clear criteria for performing elective repeat C-sections. They include, for example, amniocentesis to ensure fetal lung maturity, and date confirmation from early ultrasound.
Some deliveries must occur before 39 weeks due to mom or baby's health. These situations were not included in the study. I think what we can take away from this study is that no matter how miserable you are, wait for that 39 weeks for your delivery.
Also, if your care provider is scheduling your surgery and you will be less than 39 weeks, speak up and ask why. We do so much to protect our babies during pregnancy, we don't want to cause any unnecessary risk due to physical complaints and misery or to match someone's schedule, even your own.
36 comments posted
April 7, 2013 5:38 a.m.
Im 41 yrs old had 4 c section but wld love to have another baby can I ? i jst want to if it can b reverse or can they add some kind of tubing to connect so i can get pregnut.
- sugar B
January 25, 2013 6:09 p.m.
I wanted to finish my post,, I took a major part of my sons life and took him to theray every other day for 22 years, i spent thousands of dollars for private home therapy anything i could do, he joined a gym and worked out all the time, he wanted miricles and i prayed. All the medical help said he would no twalk past 12, he had open heart surgery again thanks to doctor T,, and a pacemaker due to another doctors mistake in judgement, people beware of elected C sections and make sure baby is ready,, Responses welcome,,
- Cynthia part 2
January 25, 2013 5:52 p.m.
Wow, I was young and the doctor who now 22 years later in prison now,, delivered me son c-section elective,, cause my son to be born at 31 weeks,, he said if i don't deliver him he will die because he is ready,, i had no labor, my water did not break and he had no proof, I was only 18 what did i know, i was afraid. He told me go to the hospital in the morbibg and say your in labor they will call me and i will deliver him,, He did, c section,, guess what, my son went into colasped lung and they took him away, then fulid built up around his heart and caused cardiac arrest, then seziure activity caused brain damage and effected his muscle actitivty restricted. My son did not come home for 12 weeks almost died and was on a respirator a long time,, he did not walk until 3 years old, very smart thank god, but struggled his entired life due to this idiot called a doctor OBGYN,, really,, sad part he is now passed,, took his life because he was tired of the struggle everyday wanting to be normal, he was so smart he knew what he was missing, graudated on the honor roll and was loved be so many people, I found my son dead in his bed and i know it was suiside, I though i would share this story as I am telling you be sure before your baby is delivered c section you have proof that baby is ready,, my life will never be the same due to this jerk,, I pray for him, he admitted to me he did the wrong thing,, I did not su I did not know better, Beware!
- Cynthia
September 16, 2012 7:12 a.m.
My sisters doctor sent her in at 38 weeks to start her and her cervix still was hard they induced her and she wasnt going anywhere. She had a c section and they let her go the next day. A few hrs later she was back bleeding from her incision and next thing you know she turned white and stopped breathing. They dont even know whats wrong. Now shes in icu on life support . Is there any specialist we can call in
- kayla
June 28, 2012 12:55 a.m.
Nathan, good question. It is 39 completed weeks. The weeks of pregnancy can be confusing.
- Mary@Mayo
June 19, 2012 6:36 p.m.
My wife will have a repeat C-Section, Due Date = Sept 15. When is earliest safe according to the 39 weeks... is it Sept 8 (39 weeks complete) or Sept 2 (in the 39th week)?
- Nathan
May 17, 2012 10:55 a.m.
What about a first c-section due to complete placenta previa? I'm 33 weeks and have been in the hospital once already with bleeding. Thankfully it stopped on its own and I haven't had any issues since, but my doctor has scheduled my c-section for 37wks due to the risk to both baby and I if we wait too long and go into labor. I have already received the steroid shot for baby's lungs during my hospital stay at 31.5wks, but I'm still concerned about an early baby and his development. I understand that this early c-section is likely what is best for both baby and I, but I still wonder.
- Tara
January 26, 2012 7:53 a.m.
"REPEAT" c-sections are typically different than the initial. For those mothers who are claiming we are being selfsih you REALLLLLLLY have no understanding of what you are speaking of. I had an emergency c-section with my first child. I did not wish to but you do what is best for the baby. Because of that surgery I was left with internal scar tissue that never healed properly. Unfortunately, for the medical boards who write this NONSENSE that is not a good enough reason to be deemed more than "elective". But let us talk about what these so called experts AREN'T telling you. If your internal scars tear you risk the life of not only yourself but your baby as well. Complications such as internal bleeding are not an issue that should be taken lightly. I have to have a second c-section. Because the Dr. has seen no physical evidence of tearing he has to call it "elective". That is because a group of board memebers who are NOT your Dr. and who do not know your body personally made it that way! Was my Dr. upset? Of course and he has been an OB for over 25 years. However, as he explained to me.. should I go early it becomes an Emergency due to the risk on my body! Remember that sometimes the risk to the mother and baby are greater than you know.. and there are not always physical signs!
- Brandi
June 23, 2011 12:53 p.m.
Jeanne, our pelvic bone in the front, the symphis pubis, is really 2 bones. As pregnancy advances, the bones can begin to separate because of the hormones of pregnancy. It is part of what helps the pelvis make room for the baby. Your grandaughter should make sure she understands why she needs a C. Section before it is done.
- Mary @ Mayo
June 22, 2011 10:59 a.m.
My grand daughter was just told that she will require a c sect because her pelvic bone is separating. She is not due till early sept. Where can I find info on this situation?
- Jeanne
January 6, 2011 1:58 p.m.
Heather, I think you are right to question the timing of your surgery. It should be what is best for you and the baby only. Ask your OB to review the American College of OB/GYN criteria for performing elective repeat C.Sections. Keep asking until you are comfortable with the answers.
- Mary @ Mayo
January 3, 2011 3:29 a.m.
Hi Mary, I have Crohn's disease and have had multiple bowel surgeries. My OB has decided I need a c-section and said we can schedule one for 38 1/2 weeks, because that falls on a Tuesday when she likes to do them. She assured me that the baby will be fine. I'm only 28 weeks now. I told her I'd prefer to go into labor and then have the c-section, but she wants my gastro surgeon involved in the procedure, so it has to be scheduled. I want to insist on waiting until I'm more than 39 weeks. Am I too worried? How often are babies due before the due date, because I'd love to even wait until 39 1/2 weeks. Is there a way to tell if the baby is ready once the scheduled c-section is close at hand? Thank you!
- Heather
October 7, 2010 5:02 a.m.
I think I'm very fortunate to have a great doctor. From beginning i wanted a c-section and my doc had no problem with that, however he only scheduled my delivery for 39weeks and 3days and I still went for a amniocentesis to make sure of lung maturity. He said he will not take out baby if its not ready. We thank the doctors who still cares. Janet - South Africa
- Janet
September 30, 2010 7:41 p.m.
Hi i do believe reading medical comments .that having a c section at nearly 38 weeks did cause medical problems for my daughter . reading heart defects that this is quite common having an early c section . I should have had a normal delivery but was sent to hospital 14 days early because i was told my baby was a large baby and to be induced which didn't work .. and by messing with nature that the birth of my daughter was a traumatic experience .. not what you would want .. at 6 weeks old my daughter was diagnosed with T.A.P.V.C. she is well and nearly 4 and i'm so proud of her such a strong and determined little girl and brave thank you my beautiful xxxx.
- sue
July 13, 2010 10:30 a.m.
I think you are very wise to wary about this plan. The American College of OB/GYN has very specific recommendations regarding the timing of repeat C. Section. The March of Dimes web site would have information for you also. If your physician feels he has a medical reason for delivering you that early, you would still need an amniocentesis to make sure the baby's lungs are mature. That involves inserting a needle into the amniotic sack and withdrawling fluid for testing. I recommend that you get a second opinion if possible. If this isn't possible then keep questioning your physician until you feel comfortable with his answers.
- Mary @ mayo.com
July 13, 2010 1:20 a.m.
HELP! On my 3rd baby, 28 weeks today. 1st baby 11.5lbs,wasn't given the option to push after the ultrasound came out-dr said her shoulders were just too wide & he'd probably break her collar bone or paralyze the left side of her face. We'd been trying for 3 years,I didn't question it.6 yrs later,2nd baby-waited so long for her I didn't like the VBAC risks. she came out 9lb12oz, truly believe I couldve pushed her out though. neither pregnancy did I have diabetes or any other problems, nor do I have gestational diabetes or other health issues with now. Dr had to do a t cut on the 2nd baby so her head could fit out of the incision and says because of that I should take this one out at 36 weeks. I REALLY DON'T WANT TO! I understand VBAC is not really an option at this point for me, i'm fine with the necessary csexn, but at 36 weeks??? It just kept sounding like it was more 'convenient' the way it was explained to me. Help??? i've been combing the internet trying desperately to seek answers on why an early planned c section. i belong to a HMO and feel a 2nd opinion with another dr would be stacked against me anyhow. any thoughts, direction as to where else I can look would be much appreciated.
- amy
May 5, 2010 2:07 p.m.
Shell, I really can't answer your question without knowing more. I think you might find resources about the medical complications with her pelvic bones. That might lead to more understanding about the need for a C Section. I'm sorry I couldn't be of more help.
- Mary @ Mayo.com
May 4, 2010 11:46 a.m.
My daughter has been informed by her doctor due to medical complications with her pelvic bones that she will have to C-Section if she ever gets pregnant. They told her it will break her pelvic bone. Where do I find more information on what causes this kind of condition.
- Shell
April 27, 2010 4:27 p.m.
This post is primarily to address those wondering, "Why?". The reality is, there ARE valid reasons for scheduling repeat c-sections. I've had 6, altogether, though this certainly wouldn't have been my first choice. I'll spare you all the complicated history and multiple difficulties I've encountered with each of my pregnancies. Suffice it to say that two surgeries were emergency and the following 4 were scheduled because the "benefit outweighed the risk". And yes, three of those were even scheduled prior to 39 weeks. The specialist pushed for 37 weeks but I would not relent and all were performed between 37 1/2 weeks-39 weeks. Two of those resulted in babies having to go to the NICU. Was it fun? No. Ideal? No. Necessary? Absolutely. I don't enjoy the NICU experience. I've had LOTS of experience there, unfortunately. My preemie died in the NICU 9 years ago. So, while 10 days in the NICU and then 48 hours in the NICU with births number 5 & 6 were not my idea of a picnic, my babies are happy, healthy & growing well...AND they have a momma to raise them.
- Amy
April 10, 2010 11:06 p.m.
My first was an emergency c-section (baby in distress) at 37 1/2 wks. My doctor said second would have to be c-section because the small town we live in does not have the trained staff to be on call if a VBAC is attempted and an emergency c-section is necessary. Second and later c-sections require more care in cutting through scar tissue. Now pregnant with #3, and the only thing that concerns me is having discomfort from scar tissue "fusing" organs. Both of my previous c-sections were performed by different doctors, and 3rd will be another doctor. Mississippi has a high litigation rate and ob/gyn's can't afford malpractice insurance here.
- Jennifer
March 31, 2010 11:50 a.m.
I am really confused..my first daughter was a natural vaginal birth and very straight forward other than having to be induced at 38 wks due to gestational diabetes. My second baby due on 28th April 2010 would have had to be delivered naturally at 38 weeks again to avoid the complications associated with the diabetes. However, baby is breech and I have been advised to opt for c-section. Do the same risks associated with the babies lungs development present themselves at 38 weeks whether the birth is natural or c-section? Because my first daughter had no complications at all.
- TPB
March 25, 2010 2:09 p.m.
I recently wrote a blog about elective primary c. sections. That referred to electing to have the c. section without an indication. This blog is about scheduled repeat c. sections. Some times repeat c.sections are referred to as elective but that is generally a way of saying there are no other indications. I don't think any woman should be judged for how her baby comes out of her body. The decision should be made between the health care provider and the woman and the decision should be based on having all the information, pros and cons.
- mary@mayo
March 10, 2010 7:47 a.m.
I think it is unfortunate that c-sections after vaginal birth(VBAC) is considered "elective c- sections. I'm having and "elective c-section" for my third child after having two previous c-sections. The last one being an emerency and having a child with severe cerebral palsy, epilepsy, feeding tubes, and neurogenic bladder. All of this due to attempting a VBAC and having a uterine rupture and placenta abruption. So after all of that and knowing the risks to me and my baby, am I "electing" to have a c-section or is my doctor and I doing the responsible thing and delivering my baby at 38 weeks to prevent a repeat uterine ruptrue? "elective" should be applied to those that have no medical necessity but do it for convienece of doctor or mother, and physical comfort level. Judgment is not necessary but restrictions to both mother and doctor should be applied
- Cheryl
February 19, 2010 9:04 p.m.
this is my second pregnancy. my first daughter was delivered by c-section after i had 2 inductions that left me dialated to barely a one. i have 2 sisters that also had to have c-sections. we had no choice c-section was our only option. this pregnancy has been full of new surprises for me. i was diagnosed with a threatened miscariage at 8 weeks, than at 25 weeks i developed superficial thombophlebitis which spread from below my knee to the top of my hip in a 2 week period, now at 28 weeks i have been diagnoses with gestational diabetes (just found out today YEAH!). my doctor had said we will schedual a repeat c-section 1-2 weeks early she doesn't want to do it any earlier for the babys health. this pregnancy has had our family on pins and needles. i fear for the baby and myself. i had a miscarriage in april and it nearly killed me. i cant loose another one. i will do anything i can to ensure this baby is healthy, but i will not let them put both our lives at risk to wait a few extra weeks. this will be my last pregnancy i dont ever want to go through this again.
- Emily
July 11, 2009 4:17 p.m.
anyone to judg a mothers wishes is the one who is selfiish. A mother knows her limits and a docter would not submit if it was wrong
- sheena
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